Standing tall: Making life easier for young scoliosis patients

Letting scoliosis interfere with practicing yoga, riding her bicycle or rollerblading wasn’t an option for Jamira Bucknor, who was born with the spine-curving condition. She resisted wearing a brace, even though a pediatrician recommended one. Her parents agreed to delay the brace and practice watchful waiting.
“We kept getting (her back) x-rayed,” said Sharie Hoo, Jamira’s mother. “We knew it would start to bend a little but we were hoping, her dad and I, it would stabilize.“
The Lakeland girl did fairly well until she was about 8. Then she began leaning more and complaining about being uncomfortable. X-rays showed more curvature of her spine. “She was secure in her identity, but it made her a little more self conscious about things she wore and standing next to her sister,” said Hoo, an ultrasound technician. “She used to be straight and tall like her.“
Once curvature reached a certain point, Jamira’s doctor warned, her whole body would spin to the side.
“You don’t want to go to school,” said stepfather Chris Hoo, who is with the Lakeland Police Department. “Being spin-ly,” said Jamira, finishing her stepfather’s thought. Jamira is now 11.
For most people who have scoliosis, it’s mild enough not to need active treatment. Monitoring will suffice. Others need braces or surgery to stop or
significantly reduce the rate at which the spine curves.

Dr. Chukwuka C. Okafor, an orthopedic spine surgery specialist in Lakeland, implanted rods in Jamira’s back a year ago to stabilize her spine. The surgery took 4 hours, 25 minutes, but to Jamira’s mother it felt more like eight or nine. There were a couple of hours for preparation and a couple more for recovery. Jamira was under anesthesia.

Implanting rods can be a one-time procedure for adults. It’s more complicated for children and teens whose bodies keep growing. They need frequent
adjustments of the rods to allow for growth in the chest cavity. In the past, those adjustments meant repeat surgeries, Okafor said. Adjustment surgeries, although less intensive than the first, still needed anesthesia. A different system used for Jamira can make those adjustments less arduous. It’s called MAGEC, for magnetic expansion control, a non-invasive growth modulator.

The surgery was done with two incisions, each 1.75 inches. Remote-controlled rods 235 millimeters ( 9 and quarter inches ) long were implanted.
The rods still need lengthening as she grows but instead of going into a hospital for surgeries Jamira comes to Okafor’s office and lies on the exam table. An external remote control, containing magnets, interacts with magnets within the rods to extend their length.
“Before this, every six months the patient went back to surgery to open the spine and remove or replace the rod,” Okafor said.
“The great advantage of this novel and cutting edge treatment is that it allows (a patient) good deformity correction and good spinal stabilization without need for return to surgery.“
Jamira recovered quickly, asking to go home from South Florida Baptist Hospital in Plant City the day after surgery.
She had to stay five days to get physical therapy and make sure the rods were working. Back at school within a couple of weeks, she quickly shed the brace she was given for added protection.
“I can stand up straighter,” Jamira said. “I know I’m not leaning over…I can touch my toes.“
She’s still working on being as tall as her older sister, Janorie, but she said she’s happy she doesn’t slump standing beside her. Once her growth is complete, Okafor will have a final surgery to correct the spine.

What is scoliosis?

Jamira has congenital scoliosis, something she was born with. A section of vertebrae that should have been shaped like a cube instead was a triangular
shape, Okafor said.
Some scoliosis is neuromuscular, associated with neurological diseases like spina bifida and cerebral palsy. About 80 percent are idiopathic, from unknown causes, with adolescent idiopathic scoliosis the most common. If found early, scoliosis often can be treated with a back brace, said Tammy Durden. director of nursing and community health for the Florida Department of Health in Polk County. Braces can prevent pain and surgery while a child is growing, she said. Some newer, slim-line brace designs can be worn under clothing, said Deanna Kirkland, the department’s school health program supervisor.

Surgery gets employed when curvature is too great, threatening to endanger the functioning of the lungs and heart. Without the right treatment, patients can get severe pain as their scoliosis gets worse, Okafor said.
“It’s a very personal decision,” Sharie Hoo said. “I would say ’Pay attention to what your child (is feeling) and your mommy gut feeling.’“
Scoliosis most commonly occurs in children ages 10-15. Florida requires scoliosis screening in sixth grade. The Health Department does that screening at public and some charter schools, Durden said.
Children bend over at the waist for screening. They’re asked to put their chins on their chests and be very loose and relaxed. Using a scoliometer, a device like a level, nurses measure the highest point of the curve in a child’s back.
If one side is higher than the other when your child bends from the waist, and there appears to be a hump on the back, that’s something to check, Durden said.

About 10 percent of slightly more than 7,000 Polk sixth graders screened have enough curvature that parents or guardians are advised to consult pediatricians, she said, although not all will be found to have scoliosis.
“Some doctors elect to watch and wait,” Durden said. “Others are referred to an orthopedic (specialist) or to Shriners.“
She generally recommends Shriners Hospitals for Children, which provide free care, if parents want a specialist referral, Durden said.

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The National Scoliosis Foundation (NSF) is a patient-led nonprofit organization dedicated since 1976 to helping children, parents, adults, and health-care providers to understand the complexities of spinal deformities such as scoliosis.

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